不同意メッセージへの気づき：介護職員とのかかわりの中で出現する認知症の行動・心理症状の回避にむけたケア

Noticing Disagreement Behavioral Messages;Dementia Care to Avoid BPSD in Resident-staff Interaction

　認知症の行動・心理症状はさまざまな要因が絡み合って出現するが，介護職員のかかわりに対する反応として症状が現れることが少なくない．そこで介護職員がかかわったあとに何らかの徴候（sign）が現れる可能性があると考え，「介護職員とのかかわりの中で生じる，意識的とはいえない不安・混乱・落ち着きのなさ・あきらめを示す態度や言動」を不同意メッセージと命名した．不同意メッセージの特徴を明示することと，不同意メッセージが認められたときに，BPSDを回避することのできる介護職員の対応を明らかにすることにした．《服従》，《謝罪》，《転嫁》，《遮断》，《憤懣》という5つの不同意メッセージが抽出され，特に《服従》，《謝罪》，《転嫁》の3つは認知症高齢者の拒否的行動と捉えられにくいため，介護職員に気づかれないままにBPSDに至ることがあった．介護職員が，早い段階でこれらのメッセージに気づき，『ケアの方向性を変更する』，『状況が変化するのを待つ』，『責任転嫁のための言い訳を提案する』ということができた場合に，BPSDへの移行を防ぐことができていた．

　BPSD (behavioral and psychological symptoms of dementia) can manifest as a result of many intertwining factors in the elderly with dementia, and it is not at all rare that it manifests in response to the interaction with caregivers. We suspected some kind of behavioral signs may be seen in the elderly with dementia after interaction with caregiver. And we named these behaviors such as anxiety, confusion, restlessness, and giving-up as Disagreement behavioral messages. The characteristics of Disagreement behavioral message were identified and the reactions of caregivers that resulted avoiding BPSD when Disagreement behavioral message occurred were examined. Five disagreement behavioral messages; obeying caregiver, apologizing to caregiver, blaming it on something/someone, shutting-down, and indignation were identified. Behaviors such as obeying caregiver, apologizing caregiver, and blaming it on something/someone are difficult to be read as refusal behaviors, and they were often undetected and let to result in BPSD. BPSD were avoided when those Disagreement behavioral messages were detected by caregivers in early stage of interaction, and care givers shifted interaction approach to “change direction of care,” “wait and see mood changes,” and “suggest excuse.”